University of Dayton From the SelectedWorks of Scott E. Hall, Ph.D., LPCC-S May, 1996 Enhancing Volunteer Effectiveness Scott Hall, University of Dayton This work is licensed under a Creative Commons CC_BY-NC-ND International License. Available at: https://works.bepress.com/scott-hall/8/
Hospice techniques Enhancing volunteer effectiveness Scott E. Hall, PhD, LPCC Karen Marshall, BS, CAVNC Abstract The characteristics of being genuine/congruent, having an unconditional positive regard and an empathic understanding, can be integrated into the training volunteers receive prior to assignment with patients/families. Understanding and practicing these concepts may further promote the interpersonal relationships volunteers have with patients/families and other hospice professionals. Enhancing volunteer effectiveness Scott E. Hall, PhD, LPCC, The University of Dayton, Ohio. Karen Marshall, BS, CAVNC, Hospice of Rutherford County, Ohio. Volunteers within the hospice organization are considered a critical part of the professional services offered to individuals and families coping with terminal illness. As a link between professional staff and family members, volunteers are in the unique position to befriend and help meet family and patient needs and help facilitate the healing process. For family members, the healing process may be learning new coping strategies and new ways to view themselves without the relationship of the terminally ill family member. 1 For the patient, the healing process may simply mean coming to peace with their life and the finality of the illness. In either case, it is critical for a trusting and caring relationship to exist between the volunteer and the family and/or patient. Volunteers within the hospice organization are considered a critical part of the professional services offered to individuals and families coping with terminal illness. A major part of developing this kind of relationship is based on effective communication. When an individual decides to become a hospice volunteer, s/he typically receives training on numerous topics prior to being placed with families and patients. One component of the training package focuses on communication techniques. Verbal communication (i.e. tone, inflection, and volume) and nonverbal communication (i.e. eye contact, gestures, and posture) are reviewed with a basic understanding of communication barriers such as language differences, physical problems, and an individual s perception of words. In addition, volunteers are shown ways to encourage communication, including validating statements and active listening techniques. Core conditions Although techniques are important, the development of a trusting and caring relationship is greatly enhanced by including concepts found in the mental health field, specifically, the core conditions of person-centered therapy (congruence/genuineness, unconditional positive regard, and empathic understanding) by 22 The American Journal of Hospice & Palliative Care
Carl Rogers. It is not the intent to make volunteers mental health counselors, but to provide a framework for interaction that is effective in all personal relationships, not just psychotherapy. 2 Congruence, or genuineness is a characteristic that implies that an individual is real with the person they are speaking with. In other words, the individual does not hide behind a false front, but provides honest communication about how s/he feels in a certain situation. This does not mean, however, that one should impulsively share all feelings, since self-disclosure must also be appropriate. 3 When volunteers acknowledge the underlying emotions associated with the client s experience in relation to similar feelings they have had, it begins to unleash an empathic view of the client. The second core condition to be communicated is an unconditional positive regard. This is a deep, genuine, unconditional caring for the other person, without judging his/her thoughts, feelings, or behaviors as good or bad. There is an acceptance of the other person/s for who they are not who they should be or what they should do. The client should be made to feel that s/he can express feelings and experiences without the risk of rejection. 4 The third, and sometimes most difficult, characteristic of the relationship is to develop an accurate empathic understanding toward the client. The challenge is to understand the client s subjective view of their experience in the here and now. Empathy is more than simply stating to the client, I understand your problem. A person begins to develop empathy toward clients when they turn inward and acknowledge feelings similar to their clients feelings without losing separateness of their own identity. For instance, the person may not have experienced the same situation as a client, but they can relate to the feelings of frustration or sadness the client is expressing. When volunteers acknowledge the underlying emotions associated with the client s experience in relation to similar feelings they have had, it begins to unleash an empathic view of the client. 5 Training on the core conditions Now that there is a basic understanding of the core conditions, the question becomes how to integrate these concepts into the training volunteers receive. When researching this topic, one rural, medium-size hospice in North Carolina was found to be already addressing the core conditions in a unique way without actually identifying them as such. Congruence/genuineness In order for an individual to communicate in a congruent or genuine way, s/he must be aware of his/her true self so that an honest dialogue can occur with patients, families, and other hospice staff. Part of this awareness includes an understanding of one s own biases, personality, and reasons for becoming a hospice volunteer. Hospice of Rutherford County in North Carolina provides this opportunity which begins with the application phase of employment. Potential volunteers are asked to identify on the application form if a death in their immediate family had occurred within the last year. If a candidate answers yes, then s/he is not typically placed with patients and families for one year so that any unresolved issues may be worked through. In order for an individual to communicate in a congruent or genuine way, s/he must be aware of his/her true self so that an honest dialogue can occur with patients, families, and other hospice staff. The training environment is another way for the volunteer to develop a sense of congruence and address personal biases prior to placement. During training, volunteers are introduced to a variety of situations including possible family situations, living arrangements, and family dysfunctions. As reactions are shared and personal insights gained, volunteers are encouraged to be honest with the volunteer coordinator concerning their level of comfort in certain home environments. If volunteers recognize strong negative feelings emerging within themselves concerning specific family situations, they should avoid putting themselves in such a situation. The American Journal of Hospice & Palliative Care 23
When a patient assignment becomes available, a volunteer is called and given all the information collected at the interdisciplinary group meeting and provided the opportunity to accept or decline the assignment. The role of the volunteer within the hospice organization goes undisputed as an effective and critical connection to the patients and families served. When communicating with patients and families, volunteers are encouraged to share feelings only when appropriate and to act mainly as a sounding board for the patient and family members. However, volunteers are cautioned against giving advice. If the volunteer is having trouble with what the patient/family is sharing (i.e. anger with God, dysfunctional relationships observed, etc.) the volunteer should share his/her concerns with other hospice professionals. The idea of involving other team members is highlighted in each of the training sessions. These training sessions, presented by the professional hospice staff, can add to the volunteer s level of comfort in calling on other team members. Unconditional positive regard Developing an accepting and unconditional positive regard toward patients and families is a key characteristic to be encouraged and integrated into each of the volunteer training sessions. One of the fundamentals of hospice care is to give the patient/family control over the amount and type of care received. Therefore, it is important for the hospice worker to provide acceptance and unconditional support of the patient/family, regardless of the care chosen. An example would be the family that is offered certified nursing assistant help, but who declines; or the family that only wants the social worker to make phone call visits, even though the care givers report high stress. This attitude carries over to accepting the patient/family s feelings and attitudes as their right. Once the hospice worker understands and accepts the patient/family rights, they will be in a position to provide unconditional positive regard. This is why the hospice philosophy is so important during training. The volunteers role is not to satisfy their own agenda, but to satisfy the patient/family needs. During training, volunteers are also provided a listing of general patient rights to reinforce this idea. Another way to help prepare the volunteers to be unconditional in their support, is to discuss, during training, the patient/family emotions and situations which might be encountered; such as anger, strained relationships, and emotional shifts that might occur with terminally ill patients, etc. The goal is to educate the volunteer to things they may encounter. Through preparation, volunteers gain the knowledge and insight to be accepting toward the patient and family. Empathic understanding As discussed earlier, communicating with empathy can enhance the relationship by enabling the volunteer to relate to the patient/family on a deeper and more connected level. However, part of developing an empathic understanding is for volunteers to first acknowledge similar feelings within themselves. Hospice of Rutherford County integrates this concept into part of their communication training. Sample...communicating with empathy can enhance the relationship by enabling the volunteer to relate to the patient/family on a deeper and more connected level. case studies are given and participants are asked to list all the feelings they think the patient and family would have, and then to discuss how their personal feelings relate to those of patients/families. Although the volunteer should empathize with a patient/family, they should not say to the patient/family, I know exactly how you feel, or turn the conversation into a me session. This may sound contradictory, but remember that having an empathic understanding is more of an internal process, or an underlying personal relationship to the feelings a patient or family is expressing. Conclusion The role of the volunteer within the hospice organization goes undisputed as an effective and critical connection to the patients and families served. And like all helping pro- 24 The American Journal of Hospice & Palliative Care
fessions, communication is a key component in developing a positive and meaningful relationship between the care giver and client. In addition to the excellent training volunteers receive prior to placement, there is an opportunity to integrate concepts from the mental health field that would enhance relationships. Specifically, the core conditions of client-centered therapy (congruence/genuineness, an unconditional positive regard, and an empathic understanding). Training on these topics does not qualify volunteers as therapists, but does provide them with the personal insight toward themselves and others that may prove beneficial in providing the utmost in quality care. References 1. Craig M: Volunteer services. The American Journal of Hospice & Palliative Care, March/April 1994: 33-35. 2. Corey G: Theory and practice of counseling and psychotherapy (4th ed.). Pacific Grove, CA., Brooks/Cole, 1990. 3. Ibid. 4. Rogers C: Carl Rogers on personal power: Inner strength and its revolutionary impact. New York: Delacorte Press, 1977. 5. Corey G, loc. cit. The American Journal of Hospice & Palliative Care 25